Excerpt

Myocardial infarction (MI) remains one of the most dramatic presentations of coronary artery disease (CAD). Complete occlusion of the artery often produces myocardial necrosis and the classical picture of a heart attack with severe chest pain, electrocardiographic (ECG) changes of ST-segment elevation, and an elevated concentration of myocardial specific proteins in the circulation. Such people are described as having a ST-segment elevation myocardial infarction (STEMI). Intermittent or partial occlusion produces similar, but often less severe clinical features, although no or transient and undetected ST elevation. Such cases are described as a non-ST segment elevation myocardial infarction (NSTEMI). People who have suffered from either of these conditions are amenable to treatment to reduce the risk of further MI or other manifestations of vascular disease, secondary prevention.

Contents

• Guideline development group members
• Acknowledgments
• 1. Introduction
  • 1.1.1. Epidemiology
  • 1.1.2. Secondary prevention of myocardial infarction
  • 1.1.3. Changes in the universal definition of myocardial infarction
  • 1.2. Introduction (2007)
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Who developed this guideline?
  • 2.4. What this guideline covers
  • 2.5. What this guideline does not cover
  • 2.6. Relationships between the guideline and other NICE guidance
• 3. Methods
  • 3.1. Methods (2013)
  • 3.2. Developing the review questions and outcomes
  • 3.3. Searching for evidence
  • 3.4. Evidence of effectiveness
  • 3.5. Evidence of cost-effectiveness
  • 3.6. Developing recommendations
  • 3.7. Methods (2007)
• 4. Guideline summary
  • 4.1. Algorithms (2013)
  • 4.2. Key priorities for implementation
  • 4.3. Key priorities for implementation (2007)
  • 4.4. Full list of recommendations
  • 4.5. Research recommendations (2007)
• 5. Lifestyle
  • 5.1. Changing diet
  • 5.2. Delivery of dietary advice
  • 5.3. Alcohol consumption
  • 5.4. Regular physical activity
  • 5.5. Smoking cessation
  • 5.6. Weight management
• 6. Cardiac rehabilitation
  • 6.1. Comprehensive cardiac rehabilitation
  • 6.2. Clinical effectiveness of cardiac rehabilitation
  • 6.3. Barriers to the uptake of and adherence to cardiac rehabilitation
  • 6.4. Interventions to increase uptake of and adherence to cardiac rehabilitation programmes
  • 6.5. Education and information provision
  • 6.6. Psychological support
  • 6.7. Sexual activity
• 7. Drug therapy
  • 7.1. Introduction
  • 7.2. Overall drug therapy recommendations
  • 7.3. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II-receptor blockers
  • 7.4. Antiplatelet therapy
  • 7.5. Beta-blockers
  • 7.6. Vitamin K antagonists
  • 7.7. Calcium channel blockers
  • 7.8. Potassium channel activators
  • 7.9. Aldosterone antagonists in patients with heart failure and LV dysfunction
  • 7.10. Statins and other lipid lowering agents
  • 7.11. Monitoring guidance
• 8. Coronary revascularisation
  • 8.1.1. Clinical effectiveness of coronary revascularisation
  • 8.1.2. Summary of recommendations
• 9. Selected patient subgroups
  • 9.1. Patients with hypertension
  • 9.2. Patients with left ventricular dysfunction
  • 9.3. Patients with an MI in the past (more than 12 months ago)
• 10. Communication of diagnosis and advice
  • 10.1.1.1. Clinical evidence
  • 10.1.2. Summary of recommendations
• 11. Acronyms and abbreviations
• 12. Glossary
• 13. Reference list
• Appendix A. Scope
• Appendix B. Declarations of interest
• Appendix C. Review protocols
• Appendix D. Clinical article selection
• Appendix E. Economic article selection
• Appendix F. Literature search strategies
• Appendix G. Clinical evidence tables
• Appendix H. Economic evidence tables
• Appendix I. Forest plots
• Appendix J. Excluded clinical studies
• Appendix K. Excluded economic studies
• Appendix L. Cost-effectiveness analysis of interventions to increase uptake and adherence to cardiac rehabilitation programmes
• Appendix M. Unit costs
• Appendix N. Research recommendations
• Appendix O. Proposed changes to the original recommendations
• Appendix P. Removed text from CG48
• Appendix Q. CG48 appendices (2007)
• Appendix R. Bibliography

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.